October 12, 2008

Columnist Ignored Conflicts of Interest

In her Sept. 28 guest column, Dr. Joey Banks ignored conflicts of interest in entrepreneurial medicine, illustrating the damage done to medicine by the "conservative revolution" and the resulting uncontrollable costs thereof. I will restrict my comments to reproductive medicine, as were hers.

Prior to 1965, when my father practiced medicine in Lewiston, Medicare and MaineCare were non-existent. Few physicians were incorporated. There was less insurance and litigation and health care costs were much lower.

Now, medicine is completely commercialized and corporate socialism is the norm.

Financial interests dictate practice and the physician-patient relationship is barely a memory.

"Caveat emptor" is the rule now, but patients are at great disadvantage in observing that admonition, because of the great authority of the physician and the unfair power balance in the relationship due to the exclusive licensure of physicians. Patients are rendered "hostage clients," also compromising their autonomy.

There is also the hexing power of medical practice, well- described by Darian Leader and David Corfield in "Why People Get Sick: Exploring the Mind-Body Connection" and amplified by Peter Breggin in "Medication Madness."

In reproductive medicine, true informed consent is often lacking. Contraceptives are powerful chemicals whose side effects, complications or alternatives are not always known or stated, especially because physicians derive perhaps 50 percent of their office revenues from their provision.

Similarly, providers have a vested financial interest in the performance of abortions, and may not know of alternatives, or may ignore them, even when referrals are made.

Dr. Banks objection to recent federal regulations was fraught with conflicting self-interest, as was her call for physicians to ignore their consciences regarding abortion and contraception.

It was also inappropriate to invoke "never to deliberately harm anyone for anyone else's interest," a strange rendering of the Hippocratic principle, "First do no harm," or, "to keep the good of the patient as the highest priority."

That is not her primary intention at all.

In fact, her column strikes me as a shabby attempt to drum up business, and a sad commentary on the ehtical state of medicine and how far we have strayed from Hippocratic ideals and our past.

Medicine used to be altruistic, philanthropic and a quasi- religious calling, in overriding service to humanity. Now, the god of commerce occupies the sacred temple of medicine, and we are all the worse for it.Paul Corrao, M.D., Lewiston

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